CDC-RFA-DP21-2109.pdf

Centers for Disease Control and Prevention

NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH

PROMOTION

Community Health Workers for COVID Response and Resilient Communities (CCR)

CDC-RFA-DP21-2109

05/24/2021

Table of Contents A. Funding Opportunity Description

B. Award Information

C. Eligibility Information

D. Required Registrations

E. Review and Selection Process

F. Award Administration Information

G. Agency Contacts

H. Other Information

I. Glossary

Part I. Overview Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Subscribe" button link to ensure they receive notifications of any changes to CDC-RFA- DP21-2109. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of changes.

A. Federal Agency Name:

Centers for Disease Control and Prevention (CDC) B. Notice of Funding Opportunity (NOFO) Title:

Community Health Workers for COVID Response and Resilient Communities (CCR) C. Announcement Type: New - Type 1:

This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be considered. For this purpose, research is defined at https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52- 2.pdf. Guidance on how CDC interprets the definition of research in the context of public health can be found at https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr- 46/index.html (See section 45 CFR 46.102(d)).

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-DP21-2109

E. Assistance Listings Number:

93.495 F. Dates:

1. Due Date for Letter of Intent (LOI):

03/25/2021 Not Applicable LOI is not required or requested.

https://www.grants.gov/ https://www.grants.gov/ https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html

2. Due Date for Applications:

05/24/2021 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov.

3. Due Date for Informational Conference Call:

Date: March 31, 2021

Time: 3:30 pm - 4:30 pm U.S. Eastern Standard Time

Conference Number: 800-369-3192

Participant Code: 5479788

Join via Computer: https://adobeconnect.cdc.gov/r0er4qejjemc/

Potential applicants may also submit questions via email at: nccdphp_chw@cdc.gov

The following website will contain pre-and post-conference call information, including questions and answers submitted by potential applicants: Community Health Workers for Covid Response and Resilient Communities | CDC

F. Executive Summary:

Summary Paragraph The Coronavirus Aid, Relief, and Economic Security (“CARES”) Act of 2020 allocated funds to the Centers for Disease Control and Prevention (CDC) to states, localities, territories, tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes. CDC announces the availability of funds to achieve the goal of the CARES Act in preventing COVID- 19 and protecting the American people from related public health impacts. This Notice of Funding Opportunity (NOFO) supports this work through training and deployment of community health workers (CHWs) to response efforts and by building and strengthening community resilience to fight COVID-19 through addressing existing health disparities.

Program strategies include integrating CHWs into organizations and care teams and strengthening relevant CHW knowledge, roles, and skills to prepare them to successfully engage with existing state and/or local public health-led actions to manage COVID-19 among priority populations. Priority populations are those with increased prevalence of COVID-19 and are disproportionately impacted by long-standing health disparities related to sociodemographic characteristics, geographic regions, and economic strata. Examples include, racial and ethnic minority groups, persons who are economically disadvantaged, justice-involved, experiencing homelessness, or have certain underlying medical conditions that increase COVID-19 risk.

a. Eligible Applicants:

Open Competition

b. NOFO Type:

G (Grant)

c. Approximate Number of Awards https://www.grants.gov/ https://adobeconnect.cdc.gov/r0er4qejjemc/ mailto:nccdphp_chw@cdc.gov https://www.cdc.gov/chronicdisease/programs-impact/nofo/covid-response.htm

d. Total Period of Performance Funding:

$ 300,000,000

e. Average One Year Award Amount:

$ 1,000,000 Over a three-year period of performance, CDC will award approximately $100 million each budget year for three years with the average award varying. These grants will range approximately from $350,000 - $3 million per year depending on the size and scope of activity.

The range of funds is broad to accommodate a varied number of organizations based on capacity and a range of catchment areas whose resource needs will vary. Approximate average one-year award amounts for each component are:

Component A (Capacity Building): $600K Component B (Implementation Ready): $2M Component C (Innovation – demonstration projects): $2M

f. Total Period of Performance Length:

g. Estimated Award Date:

August 01, 2021

h. Cost Sharing and / or Matching Requirements:

No Part II. Full Text A. Funding Opportunity Description

1. Background

a. Overview The novel Coronavirus Disease 2019 (COVID-19) has impacted communities nation-wide, including all states, localities, and territorial jurisdictions. Public health crises, such as COVID- 19, exacerbate existing health disparities and inequities in the social determinants of health (SDOH), conditions in which people are born, live, learn, work, play, worship, and age. Black/African Americans, Hispanics/Latinos, and American Indian/Alaska Native populations have higher rates of unemployment; are more likely to work in essential, low-income positions that do not allow telework; live in communities with higher rates of environmental hazards; and do not have health insurance or paid sick leave through employers. Racial and ethnic minority groups, economically disadvantaged persons, justice-involved, people experiencing homelessness, and people who use drugs and/or have certain underlying medical conditions are also at risk. All of these factors increase risk of exposure to COVID-19, while limiting ability to stay home or access care when sick. Racial and ethnic minority groups also experience higher incidence of severe heart disease, diabetes, obesity, and smoking, all shown to increase the risk of severe illness from COVID-19. Furthermore, distrust of medical and governmental entities and longstanding disparities in vaccine coverage may impact achievement of high COVID-19 vaccination rates, once vaccines are widely available in these population groups.

Along with CDC’s strategies for ending the COVID-19 pandemic, focused investments are needed to decrease disparities among the populations outlined above. Initiatives that promote health equity in all policies and reduce inequities should be pursued and evaluated for effective and targeted systems’ changes across relevant sectors. Overwhelming evidence demonstrates that health is highly influenced by SDOHs such as intergenerational wealth, high quality education, stable and fulfilling employment opportunities, affordable housing, access to healthful foods, commercial tobacco-free policies, and safe green spaces for physical activity. Through partnerships around community health assessment and planning efforts, federal, state, local, tribal, and territorial governments have invested in long-range policy and environmental change plans to improve SDOHs in communities with the poorest health outcomes.

CHWs are well-positioned to reach communities, especially those disproportionately impacted by COVID-19. CHW interventions can improve uptake and access to health care services, improve communication between community members and health providers, reduce the need for emergency and specialty services, and improve adherence to health recommendations. While CHW administered interventions have a demonstrated impact, barriers to increased intervention implementation exist (e.g. insufficient numbers of trained individuals to meet existing needs;

lack of funding/reimbursement; poor integration of CHWs in multidisciplinary care teams, in the health care delivery system, or in community organizations addressing the social determinants of health; and limited communication technology).

CHWs can improve access to COVID-19 related services (e.g. testing, contact tracing, health behavior education) and management of other underlying medical conditions that increase risk of severe COVID-19 illness and adverse outcomes. Through this initiative, CDC can highlight the integral role of CHWs in increasing resiliency, and response efforts in the hardest hit communities across the nation, especially during emergency crises by supporting three components in this NOFO: Component A focuses on building capacity for CHW efforts;

Component B focuses on enhancing and expanding existing CHW efforts; and Component C focuses on developing innovative approaches to strengthening the use of CHWs.

b. Statutory Authorities This program is authorized under the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”), Public Law 116-136 and under the Public Health Service Act 42 U.S.C.

301(a).

c. Healthy People 2030 This funding opportunity focuses on COVID-19 response and community resilience addressing Healthy People 2030 goals including emergency preparedness: https://health.gov/healthypeople/objectives-and-data/browse-objectives/emergency-preparedness and vaccination: https://health.gov/healthypeople/objectives-and-data/browse-objectives/vaccnation.

For further information, please see https://health.gov/healthypeople/objectives-and-data/browse-objectives.

d. Other National Public Health Priorities and Strategies The COVID-19 pandemic requires a coordinated public health response; recipients should consider the following in their proposed work:

https://health.gov/healthypeople/objectives-and-data/browse-objectives/emergency-preparedness https://health.gov/healthypeople/objectives-and-data/browse-objectives/emergency-preparedness https://health.gov/healthypeople/objectives-and-data/browse-objectives/vaccnation https://health.gov/healthypeople/objectives-and-data/browse-objectives/vaccnation https://health.gov/healthypeople/objectives-and-data/browse-objectives https://health.gov/healthypeople/objectives-and-data/browse-objectives

Topics (e.g. social determinants of health) related to health conditions associated with increased risk of COVID-19 illness and poorer outcomes.

https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html

Centers for Disease Control and Prevention (2020). Community Preventive Services Task Force. The Community Guide. Retrieved from The Guide to Community Preventive Services (The Community Guide).

Health Resources and Services Administration (2020). Coronavirus-Related Supplemental Funding Allowable Uses Technical Assistance Resource.

https://bphc.hrsa.gov/emergency-response/coronavirus-info/supplemental-funding-uses

e. Relevant Work This NOFO will leverage previous work funded by the CDC with various public and private partners to implement and evaluate the effectiveness of different approaches for building the public health infrastructure to respond to COVID-19, particularly:

Centers for Disease Control and Prevention (2020). Public Health Crisis Response NOFO. https://www.cdc.gov/cpr/readiness/funding-covid.htm

Centers for Disease Control and Prevention (2020). CDC COVID-19 Funding for Tribes.

https://www.cdc.gov/tribal/cooperative-agreements/covid- 19.html?deliveryName=USCDC_289-DM25904

Centers for Disease Control and Prevention (2020). COVID-19 Financial Resources.

Retrieved from Financial Resources | CDC.

2. CDC Project Description

a. Approach Bold indicates period of performance outcome.

CDC-RFA-DP21-2109: Community Health Workers for COVID Response and Resilient Communities (CCR) NOFO Logic Model

Scale up Community Health Worker (CHW) actions across the nation to support COVID-19 response efforts in those communities hit hardest by COVID-19 and among populations that are at high risk for COVID-19 exposure, infection, and outcomes (priority populations).

CDC-RFA-DP21-2109: Community Health Workers for COVID Response and Resilient Communities (CCR) NOFO Logic Model

Proposed Outcomes

Proposed High Level Strategies

Short Term Outcomes: Year 1

Intermediate Outcomes:

Year 2

Long Term:>Year 3 https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html https://www.thecommunityguide.org/ https://www.thecommunityguide.org/ https://bphc.hrsa.gov/emergency-response/coronavirus-info/supplemental-funding-uses https://www.cdc.gov/cpr/readiness/funding-covid.htm https://www.cdc.gov/tribal/cooperative-agreements/covid-19.html?deliveryName=USCDC_289-DM25904 https://www.cdc.gov/tribal/cooperative-agreements/covid-19.html?deliveryName=USCDC_289-DM25904 https://www.cdc.gov/coronavirus/2019-ncov/php/open-america/financial-resources.html

Train Community Health Workers to ensure comprehensive acquisition and reinforcement of relevant knowledge, roles, and skills to support the COVID- 19 public health response to manage outbreaks and community spread.

Increased skills/capacity/roles of CHWs to provide services and support for COVID-19 public health response efforts among priority populations within communities.

Increased reach of

CHW-

influenced mitigation efforts among priority populations within communities.

Deploy Community Health to Support the COVID-19 Public Health Response to manage outbreaks and spread of COVID-19 among priority populations within communities.

Increased workforce of CHWs delivering services to manage the spread of

COVID-19.

Continued promotion and integration of CHWs into existing workforce among priority populations

Engage Community Health Workers to Help Build and Strengthen Community Resilience to mitigate the impact of COVID- 19 by improving the overall health of priority populations within communities.

Increased utilization of community resources and clinical services for those at highest risk for poor health outcomes among priority populations within communities.

Increased provision of community resources and clinical services to those at highest risk for poor health outcomes among priority populations

Decreased impact of COVID-19 on those at risk (priority populations) and settings.

Increased community resilience to respond to COVID-19 and future public health emergencies.

IMPACT

Decreased health disparities

Increased health equity

i. Purpose This new grant will address 1) disparities in access to COVID-19 related services, e.g., testing, contact tracing, immunization services etc., and 2) health outcomes and factors that increase risk of severe COVID-19 illness (e.g., chronic diseases, smoking, pregnancy) and poorer outcomes (e.g. health and mental health care access, access to healthy food, health insurance, etc.) which have been exacerbated by COVID-19 by scaling up and sustaining a nation-wide program of CHWs who will support COVID-19 response and prevention in populations at high risk and communities hit hardest by COVID-19.

ii. Outcomes Applicants are expected to focus on those outcomes that align with the three high-level strategy categories, i.e. Train, Deploy, and Engage.

Short term outcomes:

TRAIN: Increased skills/capacity/roles of CHWs to provide services and support for COVID-19 public health response efforts among priority populations within communities.

DEPLOY: Increased workforce of CHWs delivering services to manage the spread of

COVID-19.

ENGAGE: Increased utilization of community resources and clinical services for those at highest risk for poor health outcomes among priority populations within communities.

iii. Strategies and Activities

COMPONENT A: CAPACITY BUILDING

Applicants applying for Component A funding must address the four required strategies identified in bold and also select one additional strategy from the menu of strategies targeting Capacity Building efforts.

TRAIN:

Strategy CB1 (Required): Identify and collaborate with community-wide efforts to ensure comprehensive acquisition of relevant knowledge, roles, and skills by CHWs so they are prepared to successfully engage with existing state and/or local public health-led actions to manage COVID-19 among priority populations within communities.

Strategy CB2: Align training opportunities for CHWs with the primary actions of state and/or local public health led efforts to address the underlying conditions and/or environments that increase the risk and severity of COVID-19 infections among priority populations within communities.

DEPLOY:

Strategy CB3 (Required): Integrate CHWs into organizations and care teams to support the public health response to COVID-19 among priority populations within communities.

Strategy CB4: Develop and disseminate messaging that educates organizations and care teams on the critical role CHWs play in delivering services and managing the spread of COVID-19 among priority populations within communities.

ENGAGE:

Strategy CB5 (Required): Coordinate and/or promote opportunities, such as messaging/education, within communities and clinical settings to facilitate the engagement of CHWs in addressing the needs of those at highest risk for poor health outcomes, including those resulting from COVID-19.

Strategy CB6 (Required) Year 1 : Initiate and develop and/or utilize systems to document engagement of CHWs in the care, support, and follow-up across clinical and community settings of priority populations at highest risk for poor health outcomes, including those resulting from COVID-19. (Required) Year 2: Facilitate engagement of CHWs in the care, support, and follow-up across clinical and community settings of priority populations at highest risk for poor health outcomes, including those resulting from COVID-19.

Strategy CB7: Establish and strengthen partnerships between CHWs and State Medicaid agencies, relevant state or local coalitions, initiatives, professional organizations, providers, and health systems that provide resources and support for deploying CHWs to engage with priority populations at highest risk for poor health outcomes, including those resulting from COVID-19 by addressing social determinants of health (e.g. those with underlying health conditions, with decreased access to care or lacking access to routine and usual care, challenges with having social needs met, food insecurity, housing insecurity and homelessness, etc.)

COMPONENT B: IMPLEMENTATION READY

Applicants applying for Component B funding must address the four required strategies identified in bold and also select two additional strategies from the menu of strategies targeting Implementation Ready efforts.

TRAIN:

Strategy IR1 (Required): Identify and collaborate with community-wide efforts to ensure comprehensive acquisition of relevant knowledge, roles, and skills by CHWs so they are prepared to successfully engage with existing state and/or local public health-led actions to manage COVID-19 among priority populations within communities.

Strategy IR2: Ensure appropriate training opportunities to disseminate messaging for CHWs focused on reaching those with underlying conditions and/or environments that increase the risk and severity of COVID-19 infections among priority populations in order to strengthen infrastructure critical to identification of infection, appropriate follow-up, including contact tracing, and treatment among priority populations within communities.

Strategy IR3: Align training opportunities for CHWs with the primary actions of state and/or local public health led efforts to address the underlying conditions and/or environments that increase the risk and severity of COVID-19 infections among priority populations within communities.

DEPLOY:

Strategy IR4 (Required): Integrate CHWs into organizations and care teams to support the public health response to COVID-19 among priority populations within communities.

Strategy IR5: Integrate CHWs into public health emergency preparedness and vaccine deployment planning, e.g. inclusion in planning and coordination with Immunization and Public Health Preparedness Programs; existing vaccine infrastructure; and vaccine providers in the community to increase access to new and existing vaccination programs in priority populations within communities.

ENGAGE:

Strategy IR6 (Required): Coordinate and/or promote opportunities, such as messaging/education within communities and clinical settings to facilitate the engagement of CHWs in addressing the needs of those at highest risk for poor health outcomes, including those resulting from COVID-19.

Strategy IR7 (Required): Facilitate engagement of CHWs in the care, support, and follow-up across clinical and community settings of priority populations at highest risk for poor health outcomes, including those resulting from COVID-19.

COMPONENT C: INNOVATION - DEMONSTRATION PROJECTS

The demonstration project should identify an approach that employs policy, systems or environmental changes, is innovative and will train, deploy, and engage CHWs to further address health disparities and social inequities exacerbated by COVID-19 within the catchment area identified in the recipient’s Component B application. The demonstration projects should each uniquely focus on improving selected conditions of the socioecological environment (e.g., community interventions intending to reduce toxic and chronic stress, strategies that enhance community resilience; strategies that address reimbursement or other sustainable funding; strategies that increase income, housing and/or food security and support recovery from other unintended negative consequences of COVID-19 mitigation strategies; engaging employers in identifying and adopting policies that protect worker health and safety; engaging owners/overseers of multi-unit housing to identify and adopt policies that protect worker and tenant health from COVID-19 and conditions that increase COVID-19 risk). This is an opportunity to demonstrate how CHWs can incorporate interventions addressing social determinants of health, and be an integral part of innovative approaches, such as technology, payment models, communication campaigns, new ways to link to social services and/or provide “wrap-around” services, or other services that will improve health outcomes among those at greatest risk for severe COVID-19 disease.

Requirements for the demonstration project include the following:

The demonstration project must address at least 1 of the 3 overarching strategies of the NOFO: train, deploy, and/or engage;

o This proposed project must be distinctly different from what the applicants is proposing in Component B; it is not meant to be an expansion of a Component B effort. It is an opportunity to test an innovative approach that accelerates impact to ameliorate effects of COVID-19 through the use of CHWs and builds more resilient communities.

CHWs must be an integral part of the demonstration project;

The project must be implemented in communities or populations at risk for poor health outcomes as a result of COVID-19 that the applicant has identified for Component B.

The demonstration project must be aligned with the outcome(s) as described in the logic model.

The demonstration project must include a rigorous evaluation to assess the project’s impact, outcomes, and effectiveness and develop recommendations for sustainability. The applicant should plan to initiate evaluation in Year 1, continue data collection in Year 2, and complete and submit all data to CDC immediately upon completion of Year 3.

Performance measures related to Train, Deploy, and Engagement efforts for Component C and the impact on COVID-19 may be proposed by recipients based on activities conducted and finalized in collaboration with CDC and Evaluation/Technical Assistance partners, awarded through a separate NOFO. Performance measures will be reported annually, and CDC and Evaluation/Technical Assistance partners will manage and analyze the data to identify recipient program improvements, respond to broader technical assistance needs, and report to stakeholders.

1. Collaborations

a. With other CDC programs and CDC-funded organizations:

Required Collaborations:

Recipients are required to collaborate with other CDC-funded programs that are currently implementing activities to mitigate the spread of COVID-19 infection in their respective communities and address certain underlying medical conditions that increase risk of exposure to

COVID-19. These collaborations are especially essential for implementing both the training and deployment strategies of this NOFO; applicants must include letters of support to document these collaborations. Letters must be dated within 45 days of the application due date. These letters must state the role of organizations and specify how they will help the applicant achieve the goals and outcomes of the NOFO. Applicants must file the letter of support, as appropriate, name the file “CHW_LOS_Applicant Name”, and upload it as a PDF file at www.grants.gov. This will ensure that proposed activities are complementary with other CDC funded programs operating in the same area and avoid duplication of efforts. State- and/or local-level CDC funded programs to advance efforts to mitigate the spread of COVID-19 infection include:

Epidemiology and Laboratory Capacity Program:

https://www.cdc.gov/ncezid/dpei/epidemiology-laboratory-capacity.html

State (and jurisdictional) Immunization Program: https://www.cdc.gov/vaccines/imz-managers/awardee-imz-websites.html

Supporting Tribal Public Health Capacity in Coronavirus Preparedness and Response Program: https://www.cdc.gov/tribal/documents/cooperative-agreements/COVID-19- Funding-for-Tribes-Grant-Recipients-OT20-2004-508.pdf

Tribal Public Health Capacity Building and Quality Improvement Program:

https://www.cdc.gov/tribal/cooperative-agreements/tribal-capacity-building-OT18- 1803.html

Cooperative Agreement for Emergency Response: Public Health Crisis Response and COVID-19 Crisis Response Cooperative Agreement Components A and B Supplemental Funding Program: https://www.cdc.gov/cpr/readiness/funding-covid.htm

Racial and Ethnic Approaches to Community Health (REACH) Flu Vaccine Supplement.

DP18-1813. https://www.cdc.gov/nccdphp/dnpao/state-local-programs/reach/current_programs/index.html.

Encouraged Collaborations:

Recipients are also highly encouraged to collaborate with other CDC-funded programs that focus on population health approaches to reduce health disparities and address the social determinants of health that contribute to them such as injury prevention, mental health promotion, sexually transmitted disease and chronic disease prevention. These collaborations are especially essential for implementing the strengthening community resilience strategies of this NOFO. This will ensure proposed activities are complementary with other CDC-funded programs operating in the same area and avoid duplication of efforts.

b. With organizations not funded by CDC:

Required Collaborations:

Recipients are required to appropriately align their work with other national, state or nongovernmental programs that support CHWs to promote healthy communities including State Medicaid agencies.

Recipients are also required to collaborate, through formalized partnerships, supported by detail specific service agreements, with medical (e.g., Community Health Centers (CHCs), private providers, health insurers and health systems) and essential support service providers to maximize reach, increase coordination and collaboration, and support http://www.grants.gov https://www.cdc.gov/ncezid/dpei/epidemiology-laboratory-capacity.html https://www.cdc.gov/vaccines/imz-managers/awardee-imz-websites.html https://www.cdc.gov/vaccines/imz-managers/awardee-imz-websites.html https://www.cdc.gov/tribal/documents/cooperative-agreements/COVID-19-Funding-for-Tribes-Grant-Recipients-OT20-2004-508.pdf https://www.cdc.gov/tribal/documents/cooperative-agreements/COVID-19-Funding-for-Tribes-Grant-Recipients-OT20-2004-508.pdf https://www.cdc.gov/tribal/cooperative-agreements/tribal-capacity-building-OT18-1803.html https://www.cdc.gov/tribal/cooperative-agreements/tribal-capacity-building-OT18-1803.html https://www.cdc.gov/cpr/readiness/funding-covid.htm https://www.cdc.gov/nccdphp/dnpao/state-local-programs/reach/current_programs/index.html https://www.cdc.gov/nccdphp/dnpao/state-local-programs/reach/current_programs/index.html the provision of essential services in respective communities. These collaborations are essential for the successful implementation of all three NOFO strategies.

Letters of support with a firm commitment from partners should be included in the application. Applicants should submit letters of support from organizations that will have a role in helping to achieve the NOFO activities and outcomes. Letters must be dated within 45 days of the application due date. These letters must state the role of organizations and specify how they will help the applicant achieve the goals and outcomes of the NOFO. Applicants must file the letter of support, as appropriate, name the file “CHW_LOS_Applicant Name”, and upload it as a PDF file at www.grants.gov.

Community Coalition The recipients are required to either establish a new or expand an existing community coalition to serve as a formal arrangement for cooperation and collaboration among stakeholder groups to work together to achieve the short-term, intermediate, and long-term outcomes of this NOFO.

Applicants should describe the proposed or existing coalition within the project narrative.

Recipients will collaborate with the coalition to develop and carry out the program action plan to train and deploy CHWs to support the COVID-19 public health response as well as to build and strengthen resilience to mitigate the impact of COVID-19 by improving the overall health of priority populations in key communities.

The community coalition proposed by the recipient should have diverse and multi-sector representation and, at a minimum, should include the:

Recipient Community Health Worker Network Representation Healthcare organization representative (who provides services for the priority population) Local public health department representation Community representation

The community coalition should:

Demonstrate ability to leverage partnerships across settings and sectors to address key contributors to health disparities within their community (e.g., social determinants of health)

Meaningfully engage and incorporate input from those who represent the proposed priority population(s)

Use Community Based Participatory Approaches (http://ctb.ku.edu/en/table-of-contents /analyze/where-to-start/participatory-approaches/main) in their planning approach

Reflect the composition of the proposed priority population Demonstrate a history of success in working together with partners on issues relating to health or other disparities.

Demonstrate effectiveness and progress in mobilizing partners to assist in implementation of local evidence-based or practice-based improvements that are culturally tailored to the priority population(s) http://www.grants.gov

Encouraged Collaborations:

Recipients are also encouraged to establish strategic partnerships with the following types of organizations: state- and jurisdictional-recipients of other relevant Federal programs (e.g., the Health Resources and Services Administration’s State Office of Rural Health programs or Maternal and Child Health Bureau, the Centers for Medicare and Medicaid Services, and State- Medicaid Offices) and their recipients; local public health departments (for state recipients);

local health insurers; American Indian/Alaska Native tribal governments and/or tribally designated organizations; non-CDC funded Community Based Organizations; faith-based organizations; local chambers of commerce or large employers, community advocates and other stakeholders with vested interests in reducing health disparities and the social determinants of health that contribute to them.

2. Target Populations Applicants must identify and focus on populations with increased risk for or prevalence of COVID-19 or who are at increased risk for poor health outcomes from COVID-19 because they are also disproportionately impacted by long-standing health disparities as described in the Executive Summary and Background sections of this announcement. Applicants must demonstrate that the proposed catchment area(s) reflect a) the burden of COVID-19 infection rates and/or COVID-19 mortality rates and b) populations disproportionally affected by COVID- 19 infections; particularly those affected by poverty. Catchment areas are defined in this NOFO as a county, metropolitan statistical area(s) or a group of contiguous counties. These catchment areas must have significant COVID-19 disease burden, evidence of disproportionate health disparities as evidenced by poverty rates, and sufficient combined populations to allow the strategies supported by this NOFO to reach significant numbers of people (see components below for information on population size). Applicants must describe the population selected, including relevant health disparities, and how the selected interventions will improve health and contribute to a more resilient community better able to address threats such as COVID-19.

Applicants must use the following two resources to document a) poverty rates and b) COVID-19 cases and/or mortality rates:

Poverty rates may be found at https://www.census.gov/library/visualizations/interactive/2014-2018-poverty-rate-by-county.html.

COVID-19 cases and/or deaths (county level) can be found at https://covid.cdc.gov/covid-data-tracker/#county-view. The two COVID-related data points that can be used are:

o 7 Day total reported cases per 100,000 population o 7 Day total reported deaths per 100,000 population

Applicants should include the time period for the 7 day total for cases and/or deaths from the CDC COVID Data Tracker. Additional guidance on the two COVID-related data points can be found at: Community Health Workers for Covid Response and Resilient Communities | CDC

Applicants addressing racial and ethnic populations should address the inclusion of subpopulations within the identified target population that can benefit from the program strategies listed in this announcement. These subpopulations can include groups such as older https://www.census.gov/library/visualizations/interactive/2014-2018-poverty-rate-by-county.html https://www.census.gov/library/visualizations/interactive/2014-2018-poverty-rate-by-county.html https://covid.cdc.gov/covid-data-tracker/#county-view people, people with low socioeconomic status, ethnic minorities, economically disadvantaged persons, justice-involved , people experiencing homelessness, or those who traditionally do not access health care on a routine basis such as people with mental health or substance abuse disorders, non-English speaking populations, Lesbian, Gay, Bisexual, and Transgender (LGBT) populations, persons with disabilities, or other populations who may otherwise be missed by the program. In addition, applicants will be expected to provide specific activities to address the underlying health and social inequities that put many of these subpopulations at increased risk of getting sick, having more severe illness and dying from COVID-19 and other communicable and non-communicable conditions.

a. Health Disparities CDC recognizes that social and economic opportunities, health behavior, and the physical environment in which people live greatly impact health outcomes. Health disparities represent preventable differences in the burden of disease, disability, injury or violence, or in opportunities to achieve optimal health. Applicants must describe the population(s) selected, including relevant health disparities, and how selected interventions will improve health and reduce or eliminate one or more identified health disparities. This announcement provides the opportunity to incorporate interventions to address health-related social needs, (e.g., housing instability and poor quality, food insecurity, insufficient utility resources, interpersonal violence, insufficient transportation, and inadequate educational resources) for the priority populations described in the background section. This is an opportunity to demonstrate how increased awareness of available community services, navigation assistance to access services, and partner alignment to ensure that available services support community needs can positively impact health in these communities; which should all be addressed in the proposed activities.

iv. Funding Strategy Applicants must demonstrate that the proposed catchment area(s) reflect a) the disproportionate burden of COVID-19 infection rates/COVID-19 mortality rates and b) populations disproportionally affected by COVID-19 infections; particularly those affected by poverty. Catchment areas are defined in this NOFO as a county, metropolitan statistical area(s), or a group of contiguous counties. These catchment areas must have significant COVID-19 disease burden, evidence of disproportionate health disparities as evidenced by poverty rates, and sufficient combined populations to allow the strategies supported by this NOFO to reach significant numbers of people.

Applicants must use the following two resources to document a) poverty rates and b) COVID-19 cases and/or mortality rates:

Poverty rates may be found at https://www.census.gov/library/visualizations/interactive/2014-2018-poverty-rate-by-county.html.

COVID-19 cases and/or deaths (county level) can be found at https://covid.cdc.gov/covid-data-tracker/#county-view. The two COVID-related data points that can be used are:

o 7 Day total reported cases per 100,000 population o 7 Day total reported deaths per 100,000 population https://www.census.gov/library/visualizations/interactive/2014-2018-poverty-rate-by-county.html https://www.census.gov/library/visualizations/interactive/2014-2018-poverty-rate-by-county.html https://covid.cdc.gov/covid-data-tracker/#county-view

Applicants should include the time period for the 7 day total for cases and/or deaths from the CDC COVID Data Tracker. Additional guidance on the two COVID-related data points can be found at: Community Health Workers for Covid Response and Resilient Communities | CDC

Component A focuses on organizations that have some experience with CHWs and want to build capacity by expanding training and oversight plans that will lead to the increased deployment of CHWs which will result in improved health outcomes. These organizations must have approximately one year of experience in implementing a CHW program in their catchment area. The experiences of this program may have been limited in scope, i.e., focusing on a single or a few disease concerns, providing advice and guidance to direct community members to appropriate clinical services. We expect to fund approximately 35 applicants. Applications for this component will reflect services addressing a catchment area, as defined in this NOFO, as a county, metropolitan statistical area(s), or a group of counties:

up to 50,000 population, applicants may apply for up to $350K.

For 50,000 to 200,000 population, applicants may apply for up to $600K.

For 200,000+ population, applicants may apply for up to $1M.

Component B focuses on expanding deployment of CHWs in organizations with substantial (approximately 3 years) experience currently utilizing CHWs that want to amplify activities to address COVID-19 within communities resulting in improved health outcomes; we expect to fund approximately 35 applicants. Applications for this component will reflect services addressing a catchment area, as defined in this NOFO, as a county, metropolitan statistical area(s), or a group of counties:

up to 200,000 population, applicants may apply for up to $1M.

For 200,000 to 600,000 population, applicants may apply for up to $2M For 600,000+ population, applicants may apply for up to $3M.

Component C focuses on policy, systems or environmental changes, is innovative and will train, deploy, and engage CHWs to further address health disparities and social inequities exacerbated by COVID-19 within the catchment area identified in the recipient’s Component B application.

Only applicants that are approved and funded for Component B will be considered for Component C funding. We expect to fund approximately 5 recipients for Component C for up to $2M each.

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy Evaluation and performance measurement help demonstrate program accomplishments and strengthen the evidence for strategy implementation. CDC, in collaboration with identified Evaluation and Technical Assistance (TA) partners, will work individually and collectively with recipients to track the implementation of recipient strategies and activities and assess progress in achieving NOFO outcomes within the three-year period of performance. Both process and outcome evaluation will seek to answer the following questions:

Approach:

1. To what extent has the recipient’s implementation approach resulted in achieving the desired outcomes?

Effectiveness:

1. To what extent has the recipient increased the reach of Component A and B strategies to prevent and control COVID-19 infections and strengthen community resilience?

2. To what extent has implementation of Category A and B strategies led to improved health outcomes among the identified priority population(s)?

Recipients must collaborate with CDC and Evaluation/Technical Assistance partners and are strongly encouraged to submit at least two success stories per year with impacts using the NCCDPHP Success Stories Application. Information on this application is located in the Resources section of this document. CDC and Evaluation/Technical Assistance (TA) partners will implement an evaluation approach that consists of (1) ongoing monitoring and evaluation of progress through the collection and reporting of performance measures by recipients, (2) a CDC-and Evaluation/TA partner-led comprehensive evaluation, and (3) recipient-led evaluations, with support from CDC and Evaluation/TA partners, as appropriate.

Performance measures developed for this NOFO correspond to the high-level broad strategy categories and outcomes described in the logic model. All measures are broadly stated and may be refined with recipients, CDC, and Evaluation/TA partners, based on activities proposed and recipient needs. CDC and the Evaluation/TA partners, as appropriate, will work with recipients on operationalizing and further defining each performance measure and guidance will be provided prior to the first year of expected recipient reporting.

Performance measures will be reported semi-annually by all recipients to CDC and the Evaluation/TA partners, who will also manage and analyze the data to identify recipient program improvements, respond to broader technical assistance needs, and to report to stakeholders. CDC and the Evaluation/TA partners will analyze recipient submitted performance measure data and develop aggregate performance measure reports to be disseminated to recipients and other key stakeholders, including federal partners, non-funded partners, and policy makers, as appropriate.

These aggregate findings may also be presented during site visits and recipient meetings. In addition to performance measures reported by recipients, CDC will track all outcome measures (not listed in required recipient table for reporting) that are relevant to the program through national data sets or the comprehensive evaluation activities. As part of the comprehensive evaluation activities, a subset of NOFO recipients will be selected who will be required to work collaboratively with CDC and the Evaluation/TA partners to report more in-depth narratives of activities over the course of the NOFO.

For the CDC- and Evaluation/TA partner-led comprehensive evaluation activities, CDC will lead the design, data collection, analysis, and reporting. Recipients will be expected to participate in evaluation activities such as surveys, interviews, case studies, and other data collection efforts to ensure there is a robust evaluation of the evidence-driven, community tailored/adapted efforts of the role CHWs play in leading, supporting, and collaborating with a wide variety of stakeholders to improve the health of the community. An appropriate level of guidance and support, including one on one outreach, small peer-to-peer learning and sharing opportunities, webinars, learning collaboratives, electronic resources, and virtual engagements to showcase successes and brainstorm the resolution of potential challenges will be provided to the recipients. These connections among recipients, CDC and the Evaluation/TA partners are critical to the programmatic success and effective and meaningful evaluation of this grant. CDC and the Evaluation/TA partners will use finding from these evaluation efforts to refine technical assistance and, in turn, maximize and sustain program outcomes.

For recipient-led evaluations, CDC and Evaluation/TA partners will be available to work closely, where appropriate, with recipients to develop, refine, and implement evaluation plans that they can use to make program improvements and demonstrate the outcomes and impact of their programs.

CDC, Evaluation/TA partners, and recipients will only collect data that will be analyzed and used. CDC will provide recipients with performance measure reporting templates, and potentially evaluation plan and reporting templates. CDC and Evaluation/TA partners will provide ongoing TA on program implementation efforts, recipient-led evaluation, and recipient performance measure reporting. Evaluation TA will be provided using a customized approach to ensure that the tools and services provided best meet the needs of the recipients. All evaluation findings produced by CDC, the Evaluation TA providers, and recipients will contribute to: (1) program and quality improvement of program efforts; (2) practice-based evidence; (3) documentation and sharing of lessons learned to support replication and scaling up of these program strategies and/or (4) future funding opportunities to expand upon these successes.

The data CDC collects for performance measurement and evaluation are directly related to the implementation of the strategy and/or the desired outcome indicated in the logic model. Data being collected are strictly related to the implementation of the NOFO strategies and shall be used for assessing and reporting progress and for other pertinent implementation improvement actions. All performance measure data will be collected via secure data systems. Recipients will report their performance measure data semi-annually via the data system and will have access to their data only. Over the 3-year performance period, data will be secured with limited access to authorized CDC program and evaluation staff. CDC will publish summative reports on individual and aggregate performance measure data.

Applications involving public health data collection or generation must include a Data Management Plan (DMP) as part of their evaluation and performance measurement plan unless CDC has stated that CDC will take on the responsibility of creating the DMP. The DMP describes plans for the applicant’s assurance of the quality of the public health data through the data’s lifecycle and any plans to deposit data in a repository to preserve and to make the data accessible in a timely manner. See web link for additional information:

https://www.cdc.gov/grants/additionalrequirements/ar-25.html

Short-term measures reported by recipients are described in the table below. Recipients will report one level of measures:

short-term outcomes measures for each required strategy and for each additional strategy selected

The tables below align with the logic model and shows the alignment among the overarching high level strategy categories, i.e. TRAIN, DEPLOY, and ENGAGE, along with the specific strategies, outcomes, and performance measures for Component A and Component B.

Table 1. Component A: Capacity Building -- Strategies, Outcomes, and Performance Measures

Community Health Workers for COVID-19 Response and Resilient Communities (CCR)

Table 1. Component A: Capacity Building -- Strategies, Outcomes, and Performance

Strategies (Component A Applicants are required to address the four strategies indicated in BOLD and must also select one additional strategy from any of the two areas (train/deploy) in the menu of strategies targeting capacity building (CB) efforts within this table.

Short-term Outcomes

Short-term Measures (Recipients will report short-term measures aligned with all required strategies in BOLD and the one additional strategy selected.)

Note: All measures are broadly stated and will be refined with recipients and CDC based on activities proposed.

TRAIN

Strategy CB1 (Required): Identify and collaborate with community-wide efforts to ensure comprehensive acquisition of relevant knowledge, roles, and skills by CHWs so they are prepared to successfully engage with existing state and/or local public health-led actions to manage COVID-19 among priority populations* within communities.

skills/capacity/roles of CHWs to provide services and support for COVID-19 public health response efforts among priority populations* within communities.

Measure (Required): # of CHWs successfully completing state/local public health-led COVID-19 response…